Prequalification Form for Organizations Requesting Publicly Funded Influenza Vaccine for the 2024/2025 Universal Influenza Immunization Program (UIIP)
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Forms, Links, and Information
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English - 014-4282-64e - Prequalification Form for Organizations...PDF
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French - 014-4282-64f - Prequalification Form for Organizations...PDF
Additional Information
| Form Number | 014-4282-64 |
|---|---|
| Title | Prequalification Form for Organizations Requesting Publicly Funded Influenza Vaccine for the 2024/2025 Universal Influenza Immunization Program (UIIP) |
| Description | Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine. |